Healthcare Provider Details

I. General information

NPI: 1619176831
Provider Name (Legal Business Name): TIM DAVID ESAU MSPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2007
Last Update Date: 07/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25117 SW PARKWAY AVE
WILSONVILLE OR
97070-9697
US

IV. Provider business mailing address

25117 SW PARKWAY AVE
WILSONVILLE OR
97070-9697
US

V. Phone/Fax

Practice location:
  • Phone: 503-570-3665
  • Fax: 503-570-9155
Mailing address:
  • Phone: 503-570-3665
  • Fax: 503-570-9155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number3253
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: